Hepatocellular Adenoma Clinical Presentation

Updated: Feb 21, 2018
  • Author: Bradford A Whitmer, DO; Chief Editor: BS Anand, MD  more...
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Presentation

History

The clinical presentation varies widely. Salient features of the history and physical examination may include the following:

  • Pain in the right upper quadrant or epigastric region is common, occurring in 25-50% of patients with hepatocellular adenomas.

  • Lesions may be noticed by patients as a palpable mass. Lesions may also be discovered incidentally during an abdominal imaging study for an unrelated reason.

  • History of birth control or anabolic steroid use should be elicited in patients with suspected hepatocellular adenomas.

  • Patients may also present with severe, acute abdominal pain with bleeding into the abdomen, which results in signs of shock (eg, hypotension, tachycardia, diaphoresis).

  • Hemoperitoneum occurs more frequently if the patient is taking a high-dose OCP, is actively menstruating or pregnant, or is within 6 weeks postpartum. Location of the lesion also is important, with those near the surface of the liver more prone to causing hemoperitoneum.

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Physical Examination

The physical examination findings are often nonspecific. Patients may be asymptomatic, or they may appear ill, with pallor and abdominal distress. Note the following:

  • Palpable tender or nontender mass in the right hypochondrium

  • Findings consistent with hemorrhage

  • Vital signs

  • Tachycardia

  • Hypotension

  • Orthostasis

  • Head, ears, eyes, nose, and throat (HEENT) examination

  • Anicteric sclera (Jaundice has been reported due to compression of the biliary tree by the tumor.)

  • Possible pale conjunctiva, if hemorrhage has occurred

  • Cardiovascular findings - Tachycardia if actively bleeding

  • Abdominal findings

  • Possible right hypochondrial mass with or without tenderness

  • Possible hepatomegaly

  • Possible fluid wave in cases of hemoperitoneum

  • Possible peritoneal signs, including guarding or rebound in cases of tumor rupture

  • Skin findings - Possible Grey-Turner sign or Cullen sign in cases of hemoperitoneum

  • Examination findings of the neck, chest, and extremities - Unremarkable

  • Neurologic examination findings - Unremarkable

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